— Dan Vogt (@9Vogt) February 27, 2014
We learned the difference between an “administrator” and a “coordinator” last Thursday at the Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Fla.
As MedCity News reported, two key government leaders in healthcare reform shared the stage for a much-anticipated keynote session on the last morning of HIMSS14. It was the first time Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner had been at a HIMSS conference since having “acting” lifted from her title last May. And it was the first major health IT event for Dr. Karen DeSalvo since she became national health IT coordinator in January.
I’ve been covering healthcare and health IT for a long time, but I’d never met or even heard either Tavenner or DeSalvo speak prior to Thursday. Now that I’m home from HIMSS, I’ve still never met Tavenner, and I think she prefers it that way with a lot of reporters.
Tavenner was not available for media when she became the accidental, er, acting, CMS administrator in 2011 after the Obama administration effectively abandoned Dr. Donald Berwick, who certainly belongs on the Mount Rushmore of healthcare improvement leaders, even if some don’t like his politics. Nor was she available to media after making a terribly vague announcement about leniency in Stage 2 of Meaningful Use Thursday morning.
Though the Meaningful Use news — unspecified leniency for providers claiming hardship exemptions from the requirements in 2014 — was the most important part of her talk as far as anyone in health IT is concerned, Tavenner also necessarily had to continue to sell the Patient Protection and Affordable Care Act to the healthcare industry, and, by extension, to the public.
On that front, Tavenner said that the Medicare policy of not reimbursing hospitals for certain preventable readmissions within 30 days of initial discharge has resulted in 130,000 fewer hospital admissions since CMS started measuring in 2011, providing “real quality of life for individuals.” Accountable care organizations, another component of the Affordable Care Act, have saved taxpayers a net $128 million on Medicare expenditures, she added.
“Healthcare outcomes are improving and adverse events are decreasing,” Tavenner said.
Continuing to do her job, Tavenner also pitched the insurance expansion, the most public part of the ACA. “Fixing the healthcare system cannot succeed without guaranteeing coverage for everyone,” she said. “HIT has been and will continue to be critical to that success,” she added for the benefit of the HIMSS audience.
But then she addressed the elephant in the room, a certain IT project known as healthcare.gov, and came off looking pretty silly. “I’m really tired of talking about it, but I can’t avoid it,” Tavenner said. “Maybe we should have tested healthcare.gov,” she conceded, but then said, “I think there are some things you don’t learn until you take a product live.”
We in the media still have lots of questions, but, again, Tavenner did not meet with reporters.
DeSalvo initially rubbed the bulk of the HIMSS press corps the wrong way by agreeing to on-site interviews with only two news organizations, one of which doesn’t regularly cover the health IT industry other than in terms of investments and stock prices. She also held a rather curious “meet and greet” session Tuesday for all HIMSS attendees, which, I’m told, largely was just a bunch of people moving through a line, shaking hands and taking selfies with her.
You know how previous national coordinators handled meet-and-greets at HIMSS conferences and other industry events? They got out and met everyone they could at every opportunity all week, not just for one hour in a conference room.
But DeSalvo did redeem herself in the eyes of the press by answering questions for more than half an hour following the keynote session and agreeing to follow up with many of us later. Importantly, she didn’t seem uncomfortable in what was a pretty informal press conference.
DiSalvo is the fifth person to head ONC on a permanent basis since the office was created in 2004, but the first I was personally unfamiliar with when appointed. She actually has quite an interesting history, notably helping to rebuild neighborhood health services for uninsured and low-income residents of New Orleans after Hurricane Katrina.
DeSalvo brought Katrina into her keynote, calling the current state of healthcare in the U.S. the “perfect storm” of high costs, low quality, fragmentation and other problems, all swirling around patients like a deadly hurricane.
“Every day this country creates a different disaster,” DeSalvo said, showing a satellite photo of Katrina making landfall on the Gulf Coast in 2005, then adding a political opinion.
“We face the looming decision that we will have to cut costs with an axe rather than with the precision of a scalpel,” DiSalvo said. “We have to act. … We have to get it right.”
In challenging health IT leaders to achieve nationwide EHR interoperability by 2017, DeSalvo called health IT the “central nervous system” of the nation’s healthcare system. A federal healthcare official calling the fragmented industry a “system” is significant and represents either progress or optimism. For years, Mike Leavitt, HHS secretary from 2005 to 2009, said American healthcare was a “sector,” not a “system,” because the latter implies organization.
Back in Leavitt’s day, during the second half of the George W. Bush administration, ONC operated by executive order and ran on money shifted from other HHS entities. Now, ONC is codified into law and has a real budget. Still, the national coordinator is cheerleader-in-chief for health IT initiatives, with a major bully pulpit and a lot of influence, but not much regulatory authority beyond certification of EHRs.
DiSalvo herself said that many of the health IT regulatory levers to drive interoperability are at the state level. It’s her job as coordinator to, well, coordinate the many government initiatives underway nationwide and lend a hand to the private sector. As administrator of CMS, Tavenner runs the largest single health insurance bureaucracy in the country and sets policy for state-run Medicaid programs.
Both played their roles well at HIMSS.